Professor Alan Maynard looks at clinical excellence awards, clinical audit and individual clinicans’ performance – a significant item on the NHS’s autumn agenda.

You will recall GPs benefitted from the quality outcomes framework some years ago.

The taxpayer coughed up nearly a billion pounds and the GPs rushed to meet an array of process targets, many of which did little to improve patient health - but increased the comrades’ expenditure on cars and holidays for practitioners and their families.

Professor Alan Maynard ventures into the anthropomorphic, assessing the porcine nutrition issues arising from the latest NHS redisorganisation

The American economist Uwe Reinhardt has likened a healthcare system to a sow, with beneficiaries of her milk competing for suckling rights. In the NHS, the ‘milk’ level exceeds £100 billion. Accordingly, the ‘piglets’ are bodies such as the pharmaceutical industry, hospitals and general practitioners.

Professor Alan Maynard decodes the White Paper’s literary and political influences

The primary characteristics of the recent White Paper on the NHS, Equity and Excellence: Liberating the NHS are incoherence and ambiguity. The consultation papers that have emerged subsequently do all too little to reduce the conclusion that Chairman Lansley is not sure where he is going.

’Incoherence and confusion are both an opportunity and a threat.’

Professor Alan Maynard assesses the impact of the "blank" White Paper and associated restructrings and power shifts

The White Paper published earlier this month was in effect a “blank paper”, lacking detail of both the Government’s objectives and how reform was to be achieved.

Since then, Sir Humphrey and his fellow civil servants have striven mightily not just to put flesh on the bones, but also to reveal vital parts of the skeleton which were omitted from the “blank paper”.

Professor Alan Maynard looks at what a future based around outcome measurement and new incentives will mean.

The Coalition’s reforms depend for their success on the creation of an efficient set of incentives which “bring the horses to water and makes them drink” in a co-ordinated and efficient way.

As the dust settles from the White Paper where are we? Apart from the mere issues of detail to be provided in the ten (yes, ten!) consultations in the next few weeks - essential beach reading, with comments requested by October 5th - what is changing?

Goodbye old bureaucracy, hello new bureaucracy
There is a major assault on bureaucracy, with PCTs and SHAs to go. But hold on a minute: aren’t the proposed GP commissioners just PCTs run by GPs?

Moving from 152 PCTs to 500 GP commissioning consortia (GPCCs) is like going back in time to when we had 300 or so too many PCTs.

Professor Alan Maynard looks for the evidence justifying proposed new changes. And looks. And looks …

“Christianity has not been tried and found wanting; it has been found difficult and not tried” GK Chesterton

Chesterton’s views on Christianity are replicated in healthcare by policy wonks who base their works on faith rather than evidence. The left declare all things “private” to be the devil’s work, whilst the right regard government as twice cursed!

Professor Alan Maynard OBE looks at the emerging elements and wicked issues from the current policy fog

The English NHS is scheduled to have its most significant “redisorganisation” since the 1970s. As ever, it is well-intentioned but largely evidence-free.

Furthermore, the details of the changes are lacking - and HM Treasury is currently very worried about ensuring that GPs are accountable. The idea of GP accountability is a nice issue, as primary care has largely been a data-free black hole since 1911.

You say you want a revolution …

Professor Alan Maynard OBE minds the gap between political rhetoric about openness, choice and outcomes and the practical reality of lacking comparative data – and the implications for NHS redisorganisation.

The political rhetoric is of openness in all the workings of the NHS.

The practice is of avoiding confusing consumers with facts.

Both New Labour and the new Government must know that their advocacy of patient choice is empty cant unless consumers are informed about the risks involved in using healthcare facilities.

Professor Alan Maynard OBE notes the lack of evidence for the 30-day unpaid emergency acute readmission policy, and politicians’ and policymakers’ poor use of evidence more broadly.

Politicians in all parties advocate the use of evidence in making difficult policy decisions.